Method and apparatus for tissue morcellation

ABSTRACT

The invention relates to a tissue morcellator for minimally invasive surgery. The morcellator has a metallic cutting ring mounted on a visually transparent hollow cylinder, which in combination with a visually transparent outer morcellator tube enables a surgeon to visualize the inside of the morcellator shaft for detection of loose tissue fragments in the device. A tenaculum used with the morcellation device has a spacer for preventing contact with the blade. The cutting tube can oscillate, rather than rotate, along the longitudinal axis of the cutting tube. The morcellator utilizes an extendable tissue guide on the outer tube of the morcellator shaft for preventing the tissue from rotating along the longitudinal axis of the morcellator tube. This allows the tissue to be continuously rotated into the morcellator device for continuous peel. The tissue guide can also be fully retracted to allow for coring of the bulk tissue.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/102,719 entitled “Method and apparatus for tissue morcellation” filedon Apr. 14, 2008 which claims benefit and priority to U.S. ProvisionalPatent Application No. 60/911,444, filed on Apr. 12, 2007, both of whichare hereby incorporated by reference in their entirety as if set forthin full herein.

FIELD

The present invention relates generally to the field of minimallyinvasive surgery, and in particular to a method and apparatus for themorcellation and extraction of biological, human tissue through a hollowcylindrical cutting tube that is rotated along its longitudinal axis,preferably configured as a hand-held laparoscopic device. The instrumentallows visual observation of the tissue extraction trough the cuttingtube. The instrument also incorporates a tissue guide or manipulatorthat can be extended beyond the distal position of the cutting blade ofthe tool, preventing both the coring of the tool into the tissue, aswell as rotation of the tissue along the longitudinal axis of themorcellation tool.

BACKGROUND

Several laparoscopic procedures require the bulk removal of body tissueor organs through a limited surgical opening. As such, the tissue needsto be morcellated within the body cavity into smaller pieces of tissuefrom where they can be removed with laparoscopic graspers or tenaculumsthrough minimally invasive access ports or the morcellation tool itself.Examples of such tissue morcellation are found in laparoscopicnephrectomies, splenectomies, or laparoscopic supracervicalhysterectomies.

In all laparoscopic cases for bulk removal of entire organs, it isadvantageous to morcellate the tissue into large tissue segments, ratherthan small tissue breakups, which then can be removed in very fewextraction steps. Apart from time savings, the removal of large tissuesegments, rather than small tissue chips, also reduces the chance ofcross-contamination with malignant or cancerous tissue. Specifically forthe example of laparoscopic supracervical hysterectomies, it isadvantageous to morcellate the severed uterus along the surface of thefundus (generating a continuous tissue peel), rather than torepetitively core into the bulk of the uterus (generating a multitude oftissue chips).

To accomplish laparoscopic tissue morcellation and extraction, thetissue is usually first seized with a grasper or tenaculum that isinserted into the abdomen through the inner lumen of the morcellatorshaft. In order to maintain pneunoperitoneum, the grasper or tenaculumis sealed against the morcellator shaft by a duck bill valve or floatingseal arrangement. After engaging a motor/drive mechanism to causerotation of the hollow, cylindrical cutting tube, the tissue iscontinuously cut as it is pulled into the morcellator shaft. As aresult, either small tissue fragments or rather large tissue peels canbe removed from the abdomen through the morcellation tool.

Ideally, the tissue or organ is simultaneously manipulated with a secondset of laparoscopic tools so as to place the tissue in a favorableposition in respect to the tissue morcellator. In the case ofmorcellation and removal of uteri in laparoscopic hysterectomies, forexample, it is advantageous to manipulate the severed uterus in arotating fashion in respect to the morcellator. This allows “peeling” ofthe fundus in a continuous tissue strip while simultaneously removing itout of the body cavity.

Although morcellators based on cylindrically rotating cutting tubesenable much faster and more practical tissue removal than tissue“chipping” devices, they do show some practical and functionaldisadvantages.

One drawback is that the tissue cannot be visualized as it is beingpulled into the morcellator. When tissue or bits of tissue are pulledthrough the morcellator during cutting and extraction, small pieces oftissue can be left within the shaft or seal portion of the device. Thesepieces might be pushed back into the abdomen without being noticed whenan instrument is inserted.

Another disadvantage of this arrangement is that both the shaft and theopened jaws of the grasper or tenaculum may damage the edge of thecylindrical cutting blade during manipulation, dramatically reducing itseffectiveness and life.

A functional disadvantage of the rotating cylindrical cutting tubedesign is that tissue can rotate along the longitudinal axis of thecylindrical cutting tube. This is especially the case if the tissue isin contact with the inner lumen of the rotating cutting tube, and ispronounced for rather small-sized and light tissue sections. Anarrangement of stationary inner sleeve tubes remedy this problem onlypartially if the tissue still has contact with a section of the cuttingcylinder.

Another practical disadvantage of current cutting tube arrangements interms of continuous tissue removal is that tissue being fed into themorcellator in a rotating fashion, which allows peeling of the tissue,can overspill beyond the opening of the morcellator. This prevents theremaining bulk tissue from being further rotated into the opening of themorcellator, and interrupts the continuous peel.

SUMMARY

The presented invention provides an apparatus for improved tissuemorcellation and extraction used in minimally invasive surgery,particularly laparoscopic surgery.

In one aspect, a tissue morcellation device includes a first, outercylindrical tube that is transparent, a second, inner cylindrical tubethat is transparent and positioned concentrically within a lumen of thefirst, outer tube, and a tissue guide positioned within the first, outertube. A distal end of the second, inner tube has a sharpened edge. Thesecond, inner tube is rotatable in relation to the first, outer tubeabout a longitudinal axis of the second, inner tube. The second, innertube is also movable longitudinally along the longitudinal axis withinthe first, outer tube between a first, exposed condition, in which thesharpened distal edge of the second, inner tube is positioned distal adistal end of the first, outer tube, and a second, hidden position, inwhich the sharpened distal edge of the second, inner tube is positionedproximal the distal end of the first, outer tube and within the lumen ofthe first, outer tube. The tissue guide is extendable from a first,retracted position in which the tissue guide does not extend distallybeyond the distal end of the first, outer tube to a second, extendedposition in which the tissue guide projects distally of the distal endof the first, outer tube.

The tissue morcellation device may include a third, inner cylindricaltube that is transparent and positioned concentrically within a lumen ofthe second, inner tube. The third, inner tube is stationary in relationto the first, outer tube. The second, inner tube may have a metalliccutting ring mounted on a distal portion of the second, inner tube. Themetallic cutting ring has a sharpened distal edge that forms thesharpened distal edge of the second, inner tube. Alternatively, thedistal edge of the second, inner tube is sharpened to provide thesharpened distal edge of the second, inner tube. The tissue morcellationdevice may include a vibrating element for facilitating the rotationalcutting performed by the second, inner tube. The second, inner tube maybe adapted to oscillate rotationally about the longitudinal axis inrelation to the first, outer tube. If adapted to oscillate, the second,inner tube reversibly rotates between 10° and 30° about the longitudinalaxis. When the third, inner cylindrical tube is present, the second,inner tube oscillates between the first, outer tube and the third, innertube. Alternatively, the second, inner tube and the third, inner tubemay be adapted to oscillate in opposite directions. The tissuemorcellation device may include a vibrating element for facilitating theoscillation cutting performed by the second, inner tube and the third,inner tube. The sharpened edge at the distal end of each of the second,inner tube and third, inner tube may be serrated. The tissuemorcellation device may include a seal for sealing against surgicaldevices inserted through the tissue morcellation device. The tissuemorcellation device may also include a tenaculum having a shaft and aspacer positioned concentrically on the shaft. The outer diameter of thespacer provides a loose fit between the spacer and a lumen wall of thesecond, inner tube, or the third, inner tube, when provided, to preventthe shaft of the tenaculum from touching the sharpened distal edge ofthe second, inner tube during manipulation of the tenaculum. Thetenaculum may include a handle that is configured to supply a rotatingmotion along an axis of the connecting shaft. In this manner, tissuethat is engaged with the cutting, distal end of the second, inner tubeis twisted by the rotary action of the tenaculum so that the diameter ofthe tissue is reduced for easy withdrawal from within the tissuemorcellation device. The tissue morcellation device may include avibration source adapted to vibrate the second, inner tube. Thevibration source is adjusted to facilitate tissue cutting with thesecond, inner tube with no rotational movement of the second, innertube. The tissue morcellation device may also include a hand-piece thathas a mechanical gear mechanism for generating rotation of the second,inner tube.

Many of the attendant features of the present invention will be morereadily appreciated as the same becomes better understood by referenceto the following detailed description and considered in connection withthe accompanying drawings in which like reference symbols designate likeparts throughout.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention may best be understood by reference to thefollowing description, taken in connection with the accompanyingdrawings in which the reference numerals designate like parts throughoutthe figures thereof and wherein:

FIG. 1 is a perspective drawing of a tissue morcellator being insertedinto the abdominal cavity of a patient for the extraction of body tissueor organs.

FIG. 2 is a perspective drawing of a visually transparent morcellator.

FIGS. 3 a through 3 c are close-up drawings of the distal part of avisually transparent morcellator shaft.

FIG. 4 is a schematic drawing of a grasper or tenaculum being insertedinto the morcellator cannula.

FIG. 5 shows the shaft of the grasper or tenaculum being moved againstthe cutting blade of the morcellator.

FIG. 6 is a perspective drawing of the grasper or morcellator shaftbeing applied with a sleeve to prevent damaging of the blade.

FIG. 7 shows a double-blade arrangement with oscillating cutting tubes.

FIGS. 8 a and 8 b depict a tissue guide or manipulator that has beenextended beyond the distal position of the cutting blade (8 a), and thathas been retracted into the morcellator shaft (8 b).

FIG. 9 schematically depicts the working principle of the morcellatorwith retracted tissue manipulator, allowing the morcellator to core intothe bulk of body tissue or an organ.

FIG. 10 schematically depicts the working principle of the tissuemanipulator preventing the tissue from turning over the morcellator tubeas it is guided along the surface of large body tissue or an organ.

FIG. 11 schematically depicts the working principle of the tissuemanipulator preventing the tissue from spinning along the longitudinalaxis of the morcellator shaft when the morcellator is not equipped withan inner, stationary shaft.

FIG. 12 is a perspective drawing of a laparoscopic device that is usedto rotate body tissue or an organ in order to facilitate the tissuemorcellation process.

FIG. 13 is a perspective drawing of a laparoscopic device that is usedto rotate body tissue or an organ in order to facilitate the tissuemorcellation process.

FIG. 14 is a perspective drawing of an alternate preferred embodiment ofa self-powered, laparoscopic device that is used to extract ormorcellate body tissue or organs.

DETAILED DESCRIPTION

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood to one of ordinary skill inthe art to which this invention belongs. Although any methods, devicesand materials similar or equivalent to those described herein can beused in the practice or testing of the invention, the preferred methods,devices and materials are now described.

All publications mentioned herein are incorporated herein by referencefor the purpose of describing and disclosing, for example, thestructures and/or methodologies that are described in the publicationswhich might be used in connection with the presently describedinvention. The publications discussed above and throughout the text areprovided solely for their disclosure prior to the filing date of thepresent application. Nothing herein is to be construed as an admissionthat the inventors are not entitled to antedate such disclosure byvirtue of prior invention.

The following description is provided to enable any person skilled inthe art to make and use the invention and sets forth the best modescontemplated by the inventors of carrying out their invention. Variousmodifications, however, will remain readily apparent to those skilled inthe art, since the general principles of the present invention have beendefined herein specifically to provide a method and apparatus for themorcellation and extraction of body tissue or organs.

Referring now to FIG. 1, the process of removing large-sized body tissue101 or an organ is demonstrated for a laparoscopic procedure, whichrequires very small incisions to gain access to the insufflatedperitoneal cavity 102 of a patient 103. After the organ or body tissue101 has been severed from the patient, it can be removed from theabdominal cavity by seizing it with a grasper or tenaculum 104 andpulling it through the inside lumen of a shaft 105 of a hand-heldlaparoscopic morcellation device 106. The most distal portion of themorcellation device includes a mechanical cutting mechanism that reducesthe size of the grasped tissue to fit into the inner lumen of themorcellation device 105. As a result, the two main functions of themorcellation device are to reduce the size of the tissue or organ to beremoved and to allow extraction of the morcellated tissue through theinside lumen of the device.

The working principle of a visually transparent morcellation device 200is illustrated in FIG. 2, showing the hand-piece 201 and threeconcentric transparent tubes of the device 202-204. More particularly,the morcellation device has a first, outer tube 202, a second, innertube 203 positioned within a lumen of the first, outer tube, and athird, inner tube 204, positioned within a lumen of the second, innertube. While both the outermost 202 and innermost 204 cylindrical tubesare stationary, a mechanical gear mechanism in the handpiece 201generates rotation of the center hollow cylindrical tube 203. The distalend of this cylindrical tube is provided with a sharpened edge 205 andis used to cut the tissue to be removed. The second, inner tube 203 iscapable of rotating in relation to the first, outer tube 202 about alongitudinal axis of the second tube 203. Moreover, the second, innertube 203 is enclosed in the stationary first, outer tube 202 and can bemoved longitudinally in respect to the same along the longitudinal axisso that the sharpened distal end of the second tube is either in anexposed condition, in which the sharpened distal edge of the second tubeis positioned distal a distal end of the first, outer tube, and a hiddencondition, in which the sharpened distal edge of the second tube ispositioned proximal the distal end of the first tube and within thelumen of the first tube. Also shown in FIG. 2 is a seal or septum 206that enables the surgeon to maintain the peritoneal insufflation duringinsertion and extraction of the tissue-grasping tenaculum. The seal orseptum 206 seals against surgical devices inserted through the tissuemorcellation device.

Possible configurations of visually transparent tubular arrangements areshown in FIGS. 3 a and 3 b for extended, and in FIG. 3 c for a retractedblade position. In FIG. 3 a, a sharpened metallic cutting ring 301 ismounted on a distal portion of the visually transparent, rotatingcutting cylinder 302. The metallic cutting ring 301 has a sharpeneddistal edge forming the sharpened distal edge of the second, inner ring.Alternately, the edge of the transparent cannula can be sharpened to beused as the blade 301 itself, as shown in FIG. 3 b. Also shown in FIGS.3 a, 3 b and 3 c is the visually transparent outer sleeve 303, as wellas inner tube 304 whose entire function is to prevent the tissue fromrotating as it is being pulled through the inner lumen of the device. Toprevent the plastic or metallic blade from inadvertently touching anddamaging tissue, the cutting tube 302 can be retracted within the outercylindrical tube 303, as shown in FIG. 3 c.

The insertion of a laparoscopic grasper or tenaculum 401 through theinside lumen of the tubular morcellation device into the peritonealcavity is depicted in FIG. 4. After insertion of the closed tool, thetissue is firmly grasped by the jaw elements 402. The tissue can then bepulled against the cutting edge 403 of the circulating cutting tube 404,which has been extended out of the outer sleeve 405 of the tool. As thegrasper is being pulled into the tool, continuous cutting of the tissueby the circular blade 403 leads to removal of a tissue strip out of theperitoneal cavity.

When using a tenaculum or grasper 501 with a shaft diametersignificantly smaller than the inner diameter of the inside tube 502, itis unfortunately possible to damage the sharp cutting edge 503 of themorcellation device. This is illustrated in FIG. 5, where manipulationof the shaft of the grasper or tenaculum is damaging the extended androtating cutting blade. This strongly reduces the effectiveness and lifeof the morcellation device, making it possibly necessary to use a seconddevice during the same procedure. Alternatively, the cutting blade canalso be damaged when the opened jaws are being pulled into the cuttingdevice.

One solution for this common problem is illustrated in FIG. 6. Here, theshaft 601 of the grasper or tenaculum is provided with a concentricsleeve or spacer 602. The outer diameter and tolerance of the spacerprovides a loose fit of the spacer with the lumen wall of the stationarythird, inner tube 603, preventing the shaft 601 from touching thecutting blade 604 during manipulation of the device. The spacer 602 maybe sized and configured to prevent contact between the sharpened distalportions of the morcellation device and the tenaculum, but otherwiseallow free movement of the tenaculum within the lumen of themorcellation device.

A different cutting mechanism of the tissue extractor is given in FIG.7, showing an oscillating tubular structure with at least one tubularstructure, such as the second, inner tube 701, being sharpened at thedistal end. The first, inner tube may reversibly rotate at least 90degrees, in relation to the first, outer tube 703, along itslongitudinal axis and is driven by a motor and crankshaft. As shown inFIG. 7, two cylindrical cutting tubes, such as the second, inner tube701 and the third, inner tube 702, are mounted within the stationaryfirst, outer tube 703. Either both tubes 701 and 702 can be oscillating(in opposing direction), or only the outer tube 701 can oscillate whilethe inner tube 702 remains stationary. When both tubes 701 and 702oscillate in opposing direction, they may rotate a total of at least 90degrees in relation to each other; for example, each tube rotating atleast 45 degrees in opposite directions. In comparison to the cuttingtubes being rotated around the longitudinal axis of the cannulas, theoscillatory movement does not require an inner, stationary tube toprevent rotation of the tissue as it is being pulled through the innerlumen of the morcellation device.

In a preferred embodiment, the speed of the oscillating blade(s) may bevaried to accommodate various types of tissue. An extendable-retractableprotuberance is associated with a portion of the distal end of thecoaxial cover tube of the extractor. The protuberance prevents thecutting element from coring into tissue and facilitates a “peeling”action similar to the peeling of an orange.

An additional embodiment contemplates the use of a vibrating cuttingtube where a vibration source is connected to the cutting tube andadjusted to facilitate tissue extraction where no rotational cuttingelement is used.

A further embodiment combines a vibrating element and an oscillating orrotating cutter so that cutting is facilitated by the vibration of thecutting elements. The vibration may be produced by elements that providesubsonic, sonic or ultrasonic energy distribution.

Also shown in FIG. 7 are the two cutting tubes having serrated cuttingblades 704 and 705 at the distal end of the tubes. Again, the cuttingblades can either compose of the sharpened cannula edge itself, or ofmetallic cutting rings being mounted on the distal end of thetransparent plastic cannulas.

Another arrangement for an improved morcellation and extraction deviceis given by incorporation of a tissue guide or manipulator 801positioned within the first, outer tube of the device 802. This is shownin FIG. 8 a where the tissue guide 801 is in a second, fully extendedcondition, in which the tissue guide projects distally of the distal endof the first, outer tube, and where the cutting tube 803 has beenadvanced to the cutting position. The tissue guide can be retracted to afirst, retracted position into the first, outer tube material 802, asshown in FIG. 8 b, in which the tissue guide does not extend distallybeyond the distal end of the first, outer tube. Here, in addition to theretraction of the tissue manipulator 801, also the cutting tube 803 hasbeen retracted into the outer tube of the device to disable cutting oftissue.

The working principle of the morcellator device with retracted andextended tissue guide is illustrated in FIG. 9 through FIG. 11, showingthe morcellation of large body tissue, such as an organ, as well as thesimultaneous removal of the same through the inner lumen of themorcellation device. Referring to FIG. 9, the tissue 901 has been firmlygrasped with a laparoscopic grasper or tenaculum 902 that is fed intothe peritoneal cavity through the inner lumen 903 of the morcellationdevice. With rotating or oscillating the extended cutting blade(s) 904,the grasped tissue 905 is pulled into the device where it is cut at thedistal edge of the tubular blade. As a result, the cut tissue is slowlymoved into the inner lumen of the morcellation device.

Further progress of the tissue morcellation and extraction processstrongly depends on how the tissue is delivered in respect to the distalcircular opening of the device. As shown in FIG. 9 for a device with aretracted tissue manipulator, the tissue is cut by coring the cuttingdevice into the tissue. Eventually the cutting blade will reach theopposing side of the body tissue or organ, leading to the removal ofcylindrical tissue fragment through the device. Subsequent “coring” ofthe body tissue or organ in the described fashion can be used to removethe entire bulk of the tissue.

A different result is obtained when the tissue is fed into themorcellation device with an extended tissue manipulator 1001, as shownin FIG. 10. Here, the tissue guide 1001 will prevent the coring of thebulk tissue and much rather promote morcellation along the surface ofthe tissue. This in turn allows “peeling” the tissue into long strips,allowing the surgeon to remove large tissue volumes in few extractionsteps. The peeling becomes possible as the bulk tissue 1002 starts torotate towards the tissue manipulator as it is being pulled into thedevice. At the same time, the tissue manipulator prevents tissue fromfolding over the opening of the tool 1003, which would cause coring ofthe device into the tissue. This can even be the case for large tissueenlargements 1004 being pulled into the device.

An additional effect of the tissue manipulator on the morcellationprocess of a smaller tissue volume 1101 is illustrated in FIG. 11. Inabsence of an inner stationary tube, or if a recessed inner stationarytube exposes a significant amount of the cutting tube, friction of thetissue with the inner lumen of the cutting tube, or with the exposedsection of the cutting tube, can cause the bulk tissue to spin aroundthe longitudinal axis of the tube 1102. This is prevented by theextension of the tissue guide 1103 since tissue section 1104 will bepushed against one side of the guide 1103, which prevents tissue 1101from rotating.

Still another aspect of the present invention is depicted in FIG. 12.Here, the bulk tissue or organ 1201 has first been cored in the fashiondescribed above, and is then secured with a “tissue-delivering” device1202. The device is manipulated by a co-surgeon and slowly rotates thebulk tissue or organ around the longitudinal axis of the device 1202. Amorcellation device 1203 with extended tissue guide 1204 is positionedalong the surface of the bulk tissue as shown. When grasping tissue witha grasper or tenaculum and pulling the tissue into the activated device,the rotation of the bulk tissue allows the surgeon to continuously feedthe cut tissue 1205 into the morcellation device from where it can beextracted out of the abdominal cavity.

Yet another aspect of the present invention is given in FIG. 13, showinga tenaculum or grasper 1301 that is sized and configured to work throughthe open channel of a tubular structure 1302 associated with a tissueextractor 1303 comprising a handle 1304, connecting shaft 1305 and apair of opposing grasping jaws 1306. The handle is configured to supplya rotating motion along the axis of the connecting shaft. Tissue that isengaged to the cutting end of the extractor tube is further twisted bythe rotary action of the tenaculum so that the diameter of the tissue isreduced for easy withdrawal from within the extractor tube. The rotaryaction may be supplied by a helical drive associated with a lever 1307attached to the handle 1304 or may be supplied by an electric motor. Thetwisted tissue within the cutting tube of the extractor resembles ropeand is reduced in diameter as it is elongated and twistedsimultaneously.

FIG. 14 illustrates an embodiment of the present invention where thecutting element 1401 is powered by a motor within the handle 1402 of thedevice. The power source for the motor may be external or it may be aninternal battery or battery pack 1403.

Many alterations and modifications may be made by those having ordinaryskill in the art without departing from the spirit and scope of theinvention. For these reasons, the above description should not beconstrued as limiting the invention, but should be interpreted as merelyexemplary of the embodiments. Accordingly, it is not intended that theinvention be limited, except as by the appended claims.

1. A tissue morcellation device, comprising: a handpiece; a first outercylindrical tube defining a first lumen; the first outer tube beingconnected to the handpiece; a second inner cylindrical tube defining asecond lumen; the second inner tube being positioned concentricallywithin the first lumen of the first outer tube; the second inner tubehave a sharpened distal end adjacent to a distal end of the first outertube; the second inner tube being configured to rotate relative to thefirst outer tube about a longitudinal axis of the second inner tube toeffect morcellation of tissue at the sharpened distal end so as toreduce the size of the tissue to be extracted; and wherein the secondinner tube is movable relative to the first outer tube along thelongitudinal axis between a first exposed condition in which thesharpened distal end of the second inner tube is positioned distally ofthe distal end of the first outer tube, and a second hidden position inwhich the sharpened distal end of the second inner tube is positionedproximally of the distal end of the first outer tube and within thefirst lumen.
 2. The tissue morcellation device of claim 1, furthercomprising a third inner cylindrical tube positioned concentricallywithin the second lumen of the second inner tube; the third inner tubebeing stationary in relation to the first outer tube.
 3. The tissuemorcellation device of claim 2 wherein the first outer tube, secondinner tube and third inner tube are transparent.
 4. The tissuemorcellation device of claim 1, further comprising a tenaculum having ashaft and a spacer positioned concentrically on the shaft, wherein, theouter diameter of the spacer provides a loose fit between the spacer anda lumen wall of the second inner tube to prevent the shaft of thetenaculum from touching the sharpened distal end during manipulation ofthe tenaculum.
 5. The tissue morcellation device of claim 4, thetenaculum further comprising: a handle configured to supply a rotatingmotion along an axis of the tenaculum shaft, such that tissue that isengaged with the cutting distal end of the second inner tube is twistedby the rotary action of the tenaculum so that the diameter of the tissueis reduced for withdrawal from within the tissue morcellation device. 6.The tissue morcellation device of claim 1 wherein the second inner tubecomprises a metallic cutting ring mounted on a distal portion of thesecond inner tube; the metallic cutting ring having a sharpened distalend forming the sharpened distal end of the second inner tube.
 7. Thetissue morcellation device of claim 1, further comprising a vibratingelement for rotational cutting performed by the second inner tube. 8.The tissue morcellation device of claim 1, wherein the second inner tubeis adapted to oscillate rotationally about the longitudinal axis inrelation to the first outer tube.
 9. A tissue morcellation device,comprising: a handpiece; a first outer cylindrical tube defining a firstlumen; the first outer tube being connected to the handpiece; a secondinner cylindrical tube defining a second lumen; the second inner tubebeing positioned concentrically within the first lumen of the firstouter tube; the second inner tube have a sharpened distal end adjacentto a distal end of the first outer tube; the second inner tube beingconfigured to rotate relative to the first outer tube about alongitudinal axis of the second inner tube to effect morcellation oftissue at the sharpened distal end so as to reduce the size of thetissue to be extracted; and a grasper longitudinally movable within thesecond lumen and configured to grab tissue at the distal end; thegrasper including an elongate shaft having a shaft diameter and a spacerpositioned concentrically on the shaft; the spacer extending radiallyoutwardly from the shaft to form a spacer diameter that is larger thanthe shaft diameter.
 10. The tissue morcellation device of claim 9wherein the spacer diameter is smaller than the inner diameter of thesecond inner tube to provide a loose fit between the spacer and innerwall of the second inner tube.
 11. The tissue morcellation device ofclaim 9 wherein the grasper is configured to be rotatable.
 12. Thetissue morcellation device of claim 11 wherein the grasper furthercomprises a handle at the proximal end configured to supply a rotatingmotion about the longitudinal axis of the elongate shaft of the grasper.13. The tissue morcellation device of claim 11 wherein rotary motion issupplied by an electric motor.
 14. The tissue morcellation device ofclaim 11 wherein rotary motion is supplied by a helical drive associatedwith a lever attached to the handle
 15. The tissue morcellation deviceof claim 9 wherein the grasper is configured to be rotatable withrespect to the first outer tube such that tissue that is engaged with acutting, distal end of the second inner tube is twisted by the rotaryaction of the grasper so that the tissue is reduced for withdrawal fromwithin the tissue morcellation device.
 16. The tissue morcellationdevice of claim 9 further comprising a third inner cylindrical tubepositioned concentrically within the second lumen of the second innertube; the third inner tube being stationary relative to the first outertube; and wherein the spacer diameter is smaller than the inner diameterof the third inner tube to provide a loose fit between the spacer andinner wall of the third inner tube.
 17. A tissue morcellation device,comprising: a handpiece; a first outer cylindrical tube defining a firstlumen; the first outer tube being connected to the handpiece; a secondinner cylindrical tube defining a second lumen; the second inner tubebeing positioned concentrically within the first lumen of the firstouter tube; the distal end of the second inner tube having a sharpeneddistal end adjacent to a distal end of the first outer tube; the secondinner tube being configured to rotate relative to the first outer tubeabout a longitudinal axis of the second inner tube to effectmorcellation of tissue at the sharpened distal end so as to reduce thesize of the tissue to be extracted; and a third inner cylindrical tube,the third inner tube being positioned concentrically within the secondlumen of the second inner tube; the third inner tube being stationaryrelative to the first outer tube; and a grasper longitudinally movablewithin the second lumen and configured to grab tissue at the distal end;the grasper including an elongate shaft having a shaft diameter and aspacer positioned concentrically on the shaft; the spacer extendingradially outwardly from the shaft to form a spacer diameter that islarger than the shaft diameter.
 18. The tissue morcellation device ofclaim 17 wherein the spacer diameter provides a loose fit between thespacer and inner wall of the third inner tube to prevent the elongateshaft of the grasper from touching the sharpened distal end of thesecond, inner tube during manipulation of the grasper.